<?php
include "includes/ui.php";

echo headerHTML("student","รับสมัครนักเรียน");
?>
<style>
	.medatory{
		color:red;
	}
</style>

 <div id="popupSave" class="modal hide fade" style="width:350px;top:35% !important;margin-left:-180px;" tabindex="-1" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true">

    <div class="modal-header" style='padding-top:20px;padding-bottom:25px;'>
        <button type="button" class="close" data-dismiss="modal" aria-hidden="true">×</button>
        <h3 id="myModalLabel" style="color:#72a9c9;"><img src='img/info1.png' width='24px'/><font style='font-size:18px;'>คุณต้องการบันทึกข้อมูล ?</font></h3>
    </div>
  
    <div class="modal-footer center" style="text-align:center !important;padding-top:15px;padding-bottom:15px;">
        <button type='button'  class="btn btn-primary" id="btnConfirm">ตกลง</button>
        <button class="btn" data-dismiss="modal" aria-hidden="true">ยกเลิก</button>
    </div>
 
</div> 

 	<!-- Alert -->
		<div class="alert alert-info">
			<a class="close" data-dismiss="alert"></a>
			<i class="icon-check"></i> กรอกข้อมูลนักเรียน
		</div>
		<!-- / Alert -->

<!-- Live Stats -->
<div class="row-fluid">

    <!-- Pie: Box -->
    <div class="span12">
		 <form class="form-horizontal" id="imageform" method="post" enctype="multipart/form-data" action="ajaximage.php">
				<div class="top-bar" style="padding-left: 0px;">
					<ul class="tab-container">
					  <li class="active"><a href="#tab-home"><i class="icon-user"></i> ข้อมูลส่วนตัว</a></li>
					  <li class=""><a href="#tab-messages"><i class="icon-home"></i> ที่อยู่ปัจจุบัน</a></li>
					   <li><a href="#tab-map"><i class="icon-picture"></i> แผนที่</a></li>
					  <li><a href="#tab-settings"><i class="icon-cog"></i> สำหรับเจ้าหน้าที่</a></li>
					</ul>
					 <div class='tmp' style='float:right'>
						<a href="#"><button class="btn btn-info" type='submit'  id='btnSave'  data-original-title="เพิ่มข้อมูล"  rel="tooltip">บันทึก</button></a>
					</div>
				</div>
    
					<div class="well no-padding tab-content">
					  <div class="tab-pane active" id="tab-home">
							<!-- Create Account: Form Name -->
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> ชื่อ-นามสกุล <span class='medatory'>*</span> </label>
								<div class="controls">
									<input type="text" id="txtThai_name" class="span4 m-wrap" placeholder="ชื่อนักเรียน" required maxlength="100" >
									&nbsp;<input type="text" id="txtThai_surname" class="span4 m-wrap" placeholder="นามสกุลนักเรียน" required maxlength="100" >
									&nbsp;<input type="text" id="txtThai_nickname" class="span2 m-wrap" placeholder="ชื่อเล่น" maxlength="50" ><span class="help-inline">ไทย</span>
								</div>
								<div class="controls">
									 <input type="text" id="txtEng_name" class="span4 m-wrap" placeholder="Name" maxlength="100" >
									&nbsp;<input type="text" id="txtEng_surname" class="span4 m-wrap" placeholder="Last name" maxlength="100" >
									&nbsp;<input type="text" id="txtEng_nickname" class="span2 m-wrap" placeholder="Nick name" maxlength="50" ><span class="help-inline">อังกฤษ</span>
								</div>
							</div>
							<!-- / Create Account: Form Name -->
							<!-- Create Account: Form Gender -->
							<div class="control-group">
								<label class="control-label" for="inputGender"><i class="icon-user"></i> เพศ</label>
								<div class="controls">
									<div class='row-fluid'>
										<div class="span1">
											<label class="radio line" style="padding-top:5px;">
												<div class="checker"><span><input type="radio" name="rdoSex" value="F" checked></span></div> หญิง
											</label>
										</div>
										<div class="span1">
											<label class="radio line" style="padding-top:5px;">
												<div class="checker"><span><input type="radio" name="rdoSex" value="M" ></span></div> ชาย
											</label>
										</div> 
										&nbsp;&nbsp;&nbsp;&nbsp;
									<span class="help-inline" style="font-weight:bold;">&nbsp; วันเกิด <span class='medatory'>*</span> </span>
									 <div class="input-append date btndate"   data-date="12-02-2012"  data-date-format="dd/mm/yyyy" data-date-viewmode="2" data-date-minViewMode="0">
                                        <input class="span1" style="width:100px !important;" id='txtBirthDate' required size="16" type="text"  readonly="">
                                        <span class="add-on"><i class="icon-calendar"></i></span>
                                    </div>
									 
									<input type="text" id="txtAge" class="span1 m-wrap" readonly placeholder="อายุ"/><span class="help-inline">ปี</span>
									<input type="text" id="txtAgeMonth" class="span1 m-wrap" readonly placeholder=""/><span class="help-inline">เดือน</span>
									</div>
								</div>
								
							</div>
							<!-- / Create Account: Form Gender -->
							<!-- Create Account: Form Username -->
							<div class="control-group">
								<label class="control-label" for="inputAge"><i class="icon-user"></i> ศาสนา </label>
								<div class="controls">
									<input type="text" id="txtReligion" class="span2 m-wrap" placeholder="ศาสนา" maxlength="60" >&nbsp;
									&nbsp;&nbsp;&nbsp;&nbsp; <span class="help-inline" style="font-weight:bold;">เชื้อชาติ&nbsp;&nbsp;</span>
									<input type="text" id="txtRace" class="span2 m-wrap" placeholder="เชื้อชาติ" maxlength="60">&nbsp;
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">สัญชาติ&nbsp;&nbsp; </span>
									<input type="text" id="txtNationality" class="span2 m-wrap" placeholder="สัญชาติ" maxlength="60">
								</div>
							</div>
							<!-- / Create Account: Form Username -->
							<div class="alert alert-success" style='margin-top:10px;margin-bottom:10px;margin-left:5px;margin-right:5px;'>
								<i class="icon icon-check"></i> <b>ข้อมูลบิดา - มารดา</b> 
							</div>
							<!-- Create Account: Form Nationality -->
							<div class="control-group">
								<label class="control-label" for="inputstatus"><i class="icon-user"></i> สถานภาพ</label>
								<div class="controls">
									<div class='row-fluid'>
											<div class="span2" style="width:100px !important;">
												<label class="radio line" style="padding-top:5px;">
													<div class="checker"><span><input type="radio" name="rdoParentStatus" value="M" checked></span></div> อยู่ร่วมกัน
													
												</label>
											</div>
											<div class="span2" style="width:100px !important;">
												<label class="radio line" style="padding-top:5px;">
													<div class="checker"><span><input type="radio" name="rdoParentStatus" value="D" ></span></div> หย่าร้าง
												</label>
											</div> 
											<div class="span2" style="width:100px !important;">
												<label class="radio line" style="padding-top:5px;">
													<div class="checker"><span><input type="radio" name="rdoParentStatus" value="O" ></span></div> อื่นๆ ระบุ
												</label>
											</div> 
											<input type="text" id="txtOtherParentStatus" class="span6 m-wrap" maxlength="200"  placeholder="...">
									</div>
									 
								</div>
								
							</div>
							<!-- / Create Account: Form Nationality -->
				  
						 
							<!-- Create Account: Form Father -->
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> ชื่อบิดา <span class='medatory'>*</span></label>
								<div class="controls">
									<input type="text" id="txtFather_name" required class="span3 m-wrap" placeholder="ชื่อบิดา" maxlength="100" >&nbsp;&nbsp;&nbsp;&nbsp;
									<span class="help-inline" style="font-weight:bold;" required>นามสกุล<span class='medatory'>*</span></span>
									&nbsp;&nbsp;&nbsp;<input type="text" id="txtFather_surname" required class="span3 m-wrap" placeholder="นามสกุลบิดา" maxlength="100">
									&nbsp;&nbsp;<input type="text" id="txtFather_age" name='number' class="span1" placeholder="อายุ" maxlength="2"><span class="help-inline">ปี</span>
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
									<span class="help-inline" style="font-weight:bold;">การศึกษา</span>&nbsp;
									<input type="text" id='txtFather_education' class="span3" placeholder="การศึกษา" maxlength="80"> 
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> อาชีพ </label>
								<div class="controls">
									<input type="text" id="txtFather_occupation" maxlength="120" class="span3 m-wrap" placeholder="อาชีพปัจจุบัน">
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">ตำแหน่ง &nbsp;</span>
									&nbsp;&nbsp;&nbsp;<input type="text" id="txtFather_position"  class="span3 m-wrap" placeholder="ตำแหน่ง"  maxlength="150">
									&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">&nbsp;ชื่อสำนักงาน&nbsp;</span>&nbsp;
									<input type="text" class="span4" id="txtFather_company"  placeholder="ชื่อสำนักงาน"  maxlength="150"> 
								</div>
							 
							</div>
											
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> รายละเอียด </label>
								<div class="controls">
									  <input type="text" id="txtFather_occupation_info"  class="span12 m-wrap" maxlength="200"  placeholder="รายละเอียดอาชีพที่ทำ"/>
								</div>
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> ที่อยู่ที่ทำงาน </label>
								<div class="controls">
									  <input type="text" id="txtFather_company_address" maxlength="200"  class="span12 m-wrap" placeholder="ที่อยู่ที่ทำงาน"/>
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> จังหวัด </label>
								<div class="controls">
									<input type="text"   maxlength="100" class="span2 m-wrap" id="txtFather_province" placeholder="...">
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">รหัสไปรษณีย์</span>
									&nbsp;<input type="text" id="txtFather_zipcode"  name='number' class="span2 m-wrap" placeholder="..." maxlength="5"/>
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">โทรศัพท์</span>
									&nbsp;<input type="text" id="txtFather_tele" name='number' class="span2" placeholder="..." maxlength="20"/> 
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">โทรสาร (FAX)</span>
									&nbsp;<input type="text" id="txtFather_fax" name='number' class="span2" placeholder="..." maxlength="20" />
								</div>
							 
							</div>
							
							<!-- / Create Account: Form Father -->

						  <!-- Create Account: Form Monther -->
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> ชื่อมารดา <span class='medatory'>*</span></label>
								<div class="controls">
									<input type="text" id="txtMather_name" required class="span3 m-wrap" placeholder="ชื่อมารดา" maxlength="100">&nbsp;&nbsp;&nbsp;&nbsp;
									<span class="help-inline" style="font-weight:bold;">นามสกุล<span class='medatory'>*</span></span>
									&nbsp;&nbsp;&nbsp;<input type="text" required id="txtMather_surname" required class="span3 m-wrap" placeholder="นามสกุลมารดา" maxlength="100">
									&nbsp;&nbsp;<input type="text" id="txtMather_age" class="span1 txtamt" name='number' placeholder="อายุ" maxlength="2"><span class="help-inline">ปี</span>
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">การศึกษา</span>&nbsp;
									<input type="text" id='txtMather_education' class="span3" placeholder="การศึกษา" maxlength="150">  
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> อาชีพ </label>
								<div class="controls">
									<input type="text" id="txtMather_occupation" maxlength="120" class="span3 m-wrap" placeholder="อาชีพปัจจุบัน">
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">ตำแหน่ง &nbsp;</span>
									&nbsp;&nbsp;&nbsp;<input type="text" id="txtMather_position"  class="span3 m-wrap" placeholder="ตำแหน่ง"   maxlength="150">
									&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">&nbsp;ชื่อสำนักงาน&nbsp;</span>
									&nbsp;<input type="text" class="span4" id="txtMather_company" placeholder="ชื่อสำนักงาน"   maxlength="150">
								</div>
							 
							</div>
							
							 <div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> รายละเอียด </label>
								<div class="controls">
									  <input type="text"  class="span12 m-wrap" id="txtMather_detail" maxlength="200"  placeholder="รายละเอียดอาชีพที่ทำ"/>
								</div>
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> ที่อยู่ที่ทำงาน </label>
								<div class="controls">
									  <input type="text"  class="span12 m-wrap" id="txtMather_company_address" placeholder="ที่อยู่ที่ทำงาน" maxlength="200"/>
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-user"></i> จังหวัด </label>
								<div class="controls">
									<input type="text" maxlength="100" id="txtMather_province" class="span2 m-wrap" placeholder="...">
									&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">รหัสไปรษณีย์</span>
									&nbsp;<input type="text" maxlength="5"  name='number' id="txtMather_zipcode" class="span2 m-wrap" placeholder="...">
									&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">โทรศัพท์</span>
									&nbsp;<input type="text" name='number' maxlength="20" id='txtMather_tele' class="span2" placeholder="..."> 
									&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">โทรสาร (FAX)</span>
									&nbsp;<input type="text" name='number' maxlength="20" id='txtMather_fax' class="span2" placeholder="..."> &nbsp;&nbsp; 
								</div>
							 
							</div>
							
					 
		 			</div>
					  
					  <div class="tab-pane" id="tab-messages">
						 <div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-home"></i> ที่อยู่ปัจจุบัน <span class='medatory'>*</span></label>
								<div class="controls">
									<input type="text" id='txtAddress' required maxlength="200" class="span12 m-wrap" placeholder="ที่อยู่ที่ปัจจุบัน"/>
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-home"></i> จังหวัด <span class='medatory'>*</span></label>
								<div class="controls">
									&nbsp;<input type="text" maxlength="100" required id='txtProvince' class="span3 m-wrap" placeholder="...">
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">รหัสไปรษณีย์</span>
									&nbsp;<input type="text" maxlength="5" name='number' id='txtZipcode' class="span3 m-wrap" placeholder="...">
								 
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-home"></i> โทรศัพท์มือถือ <span class='medatory'>*</span></label>
								<div class="controls">
									&nbsp;<input type="text" id='txtMobilephone' name='number' maxlength="20" required class="span2 m-wrap" placeholder="...">
									&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">โทรศัพท์บ้าน  </span>
									&nbsp;<input type="text" id='txtTelephone' name='number' maxlength="20" class="span2 m-wrap" placeholder="...">
									&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">Email</span>
									&nbsp;<input type="text" id='txtEmail'  maxlength="60"   class="span3 m-wrap" placeholder="Email">
								 
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-home"></i> เบอร์โทรผู้ปกครอง <span class='medatory'>*</span></label>
								<div class="controls">
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="text" id='txtTelephone_Parent1' name='number' maxlength="20" required class="span2 m-wrap" placeholder="...">
									&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">เบอร์โทร 2  </span>
									&nbsp;<input type="text" id='txtTelephone_Parent2' name='number' maxlength="20" class="span2 m-wrap" placeholder="">
									&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;">เบอร์โทร 3</span>
									&nbsp;<input type="text" id='txtTelephone_Parent3'  maxlength="20"   class="span2 m-wrap" placeholder="">
								 
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-home"></i> ติดต่อฉุกเฉิน <span class='medatory'>*</span></label>
								<div class="controls">
									<input type="text" required id='txtContact'  maxlength="150" class="span12 m-wrap" placeholder="เพื่อนบ้านหรือญาติสนิทที่ติดต่อได้กรณีฉุกเฉิน">
								</div>
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-home"></i> นักเรียนมีพี่ </label>
								<div class="controls">
									<input type="text" id='txtNo_of_brother1' name='number' maxlength="2" class="span2 m-wrap" placeholder="..."><span class="help-inline">คน</span>
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;"> 1.อายุ</span>
									&nbsp;<input type="text" id='txtBrother_1' name='number' maxlength="2" class="span1 m-wrap" placeholder="..."><span class="help-inline">ปี</span>
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;"> 2.อายุ</span>
									&nbsp;<input type="text" id='txtBrother_2' name='number' maxlength="2" class="span1 m-wrap" placeholder="..."><span class="help-inline">ปี</span>
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;"> 3.อายุ</span>
									&nbsp;<input type="text" id='txtBrother_3' name='number' maxlength="2" class="span1 m-wrap" placeholder="..."><span class="help-inline">ปี</span>
								 
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-home"></i> นักเรียนมีน้อง</label>
								<div class="controls">
									<input type="text" id='txtNo_of_brother2' name='number' maxlength="2" class="span2 m-wrap" placeholder="..."><span class="help-inline">คน</span>
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;"> 1.อายุ</span>
									&nbsp;<input type="text" id='txtBrother_4' name='number' maxlength="2" class="span1 m-wrap" placeholder="..."><span class="help-inline">ปี</span>
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;"> 2.อายุ</span>
									&nbsp;<input type="text" id='txtBrother_5' name='number' maxlength="2" class="span1 m-wrap" placeholder="..."><span class="help-inline">ปี</span>
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;"> 3.อายุ</span>
									&nbsp;<input type="text" id='txtBrother_6' name='number' maxlength="2" class="span1 m-wrap" placeholder="..."><span class="help-inline">ปี</span>
								 
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-home"></i> กรุ๊ปเลือด</label>
								<div class="controls">
									<input type="text" id='txtBlood'  maxlength="2" class="span2 m-wrap" placeholder="..."> 
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;"> แพ้อาหาร</span>
									&nbsp;<input type="text"  class="span4 m-wrap" maxlength="100"  id='txtFood_allergies' placeholder="..."> 
									&nbsp;&nbsp;&nbsp;&nbsp;<span class="help-inline" style="font-weight:bold;"> แพ้ยา</span>
									&nbsp;<input type="text"  class="span4 m-wrap" maxlength="100" id='txtBe_allergic' placeholder="...">  
								 
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-home"></i> โรคประจำตัว</label>
								<div class="controls">
									<input type="text"  maxlength="200"  id='txtCongenital_disease' class="span12 m-wrap" placeholder="..."> 
								 
								</div>
							 
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-home"></i> อุปนิสัยพิเศษ</label>
								<div class="controls">
									<input type="text" maxlength="200" id='txtSpecial_character' class="span12 m-wrap" placeholder="..."> 
								 
								</div>
							 
							</div>
					 </div>
					   <div class="tab-pane" id="tab-map" style='min-height:350px;'>
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-caret-right"></i> แผนที่ </label>
								<div class="controls">
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<div class="input-append">
									<input class="span12 no-margin btn text-right" name="photoimg" id="photoimg" type="file">
								</div>
								</div>
							</div>
							 
								<div class="image-display text-center" id="imgMap">  
									<img src="img/no-image.png"   class="img-polaroid">
								</div>
						  
						</div>
					  <div class="tab-pane" id="tab-settings">
					

							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-caret-right"></i> อุปกรณ์การเรียน &nbsp;<span class='medatory'>*</span></label>
								<div class="controls">
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
									<select class="no-margin" id='cboAssest' style="width:150px !important;">
									</select>
									<span class="help-inline" style="">บาท</span>
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
									<span class="help-inline" style="font-weight:bold;">ค่าธรรมเนียมการเรียน&nbsp;<span class='medatory'>*</span>&nbsp;</span>
									<select class="no-margin" id='cboTerm' style="width:150px !important;">
									</select>
									<span class="help-inline" >บาท</span>
								</div>
							</div>
						 
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-caret-right"></i> ค่าใช้จ่ายอื่น ๆ 1 </label>
								<div class="controls">
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
									<input type="text" name='number' maxlength="7"  id='txtOtherpay1' class="span2 m-wrap text-right" value="0"/>
									<span class="help-inline">บาท</span>
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
									<span class="help-inline" style="font-weight:bold;">&nbsp;ค่าใช้จ่ายอื่น ๆ 2&nbsp;</span>
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="text" id='txtOtherpay2'  name='number' maxlength="7" class="span2 m-wrap text-right" value="0"/>
									<span class="help-inline">บาท</span>
								</div>
							</div>
							
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-caret-right"></i> ใช้บริการรถโรงเรียน </label>
								<div class="controls" style='padding-left:50px !important;'> 
									<div class='row-fluid'>
										 
										<div class="span1">
											<label class="radio line" style="padding-top:5px;">
												
												<div class="checker">
													<span>
														<input type="radio" name="rdoBus" value="N" checked>
													</span>
												</div> ไม่ใช้
											</label>
										</div>
										<div class="span1">
											<label class="radio line" style="padding-top:5px;">
												<div class="checker"><span><input type="radio" name="rdoBus" value="Y" ></span></div> ใช้
											</label>
										</div> 
									
									 <input type="text" name="number" id="txtBus_fee" class="span1 m-wrap text-right" maxlength="4" value="0">
									 <span class="help-inline">บาท</span>
									 &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
									  <span class="help-inline" style="font-weight:bold;">ค่าชุดนักเรียน</span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
									  <input type="text" name='number' id="txtStudent_form_fee" maxlength="7" class="span2 m-wrap text-right" style='width:150px !important;' value="0" />
									  <span class="help-inline">บาท</span>
									</div>
									
								</div>
							</div>
							
							 
							 <div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-caret-right"></i> รายการชำระครั้งแรก </label>
								<div class="controls">
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
									<input type="text" id='txtTotal' class="span2 m-wrap text-right" placeholder="0" style='background-color:#f7e8d4;' disabled />
									<span class="help-inline" style="font-weight:bold;">บาท</span>
								</div>
							</div>
							
						
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-caret-right"></i> ชั้นปีที่มอบตัว </label>
								<div class="controls">
									&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
									<select class="no-margin span8" id="cboClass" style="width:250px !important;">
									</select>
									<span class="help-inline" style="font-weight:bold;margin-left:50px;">วันที่มอบตัว</span>
								 <div class="input-append date btndate"   data-date="12-02-2012"  data-date-format="dd/mm/yyyy" data-date-viewmode="0" data-date-minViewMode="0">
                                        <input class="span1" style="width:100px !important;" id='txtRegisterDate' required size="16" type="text"  readonly="">
                                        <span class="add-on"><i class="icon-calendar"></i></span>
                                    </div>
								</div>
							</div>
							 
							<div class="control-group">
								<label class="control-label" for="inputName"><i class="icon-caret-right"></i> ผู้แนะนำ </label>
								<div class="controls">
								&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
								<input type="text" maxlength="100" id='txtRecommance' class="span4 m-wrap" placeholder="....."> 
								</div>
							</div>
							<div class="control-group">
							<label class="control-label"><i class="icon-caret-right"></i>เอกสาร</label>
							<div class="controls">
							 <div class="row-fluid">
									<div class="span3">
										<label class="checkbox line">
										<div class="checker"><span><input type="checkbox" name='doc_address' id='doc_address' value="Y"></span></div> สำเนาทะเบียนบ้านเด็กและผู้ปกครอง
										</label>
										<label class="checkbox line">
										<div class="checker"><span><input type="checkbox" name='doc_idcard' id='doc_idcard' value="Y"></span></div> สำเนาบัตรประชาชน
										</label>
										<label class="checkbox line">
										<div class="checker"><span><input type="checkbox" name='doc_birth' id='doc_birth' value="Y"></span></div> สำเนาสูติบัตร
										</label>
									</div>
									<div class="span3">
										<label class="checkbox line">
										<div class="checker"><span><input type="checkbox" name='doc_healty' id='doc_healty' value="Y"></span></div> สำเนาสุขภาพเด็ก
										</label>
										<label class="checkbox line">
										<div class="checker"><span><input type="checkbox" name='doc_pic_chident' id='doc_pic_chident' value="Y"></span></div> รูปถ่ายเด็ก 4 รูป ขนาด 1"
										</label>
										<label class="checkbox line">
										<div class="checker"><span><input type="checkbox" name='doc_pic_parent' id='doc_pic_parent' value="Y"></span></div> รูปถ่ายผู้ปกครอง 3 ท่านขนาด 1"
										</label>
									</div>
								</div>
							</div>
						</div>
						
					  </div>
					 
					</div>

			 </form>	 
    </div>
    <!-- / Pie -->

</div>
<!-- / Live Stats -->

<?php
echo footerHTML();
?>

<!-- Javascript
================================================== -->
<!-- Placed at the end of the document so the pages load faster -->
<script src='js/jquery.hotkeys.js'></script>
<!--script src='js/fullcalendar.min.js'></script-->
<script src="js/jquery-ui-1.10.2.custom.min.js"></script>
<script src="js/jquery.pajinate.js"></script>
<!--script src="js/jquery.prism.min.js"></script-->
<script src="js/jquery.dataTables.min.js"></script>

<script src="js/jquery.flot.resize.js"></script>
<script src="js/bootstrap.min.js"></script>
<script src="js/bootstrap-wysiwyg.js"></script>
<!--script src="js/bootstrap-typeahead.js"></script-->
<script src="js/jquery.easing.min.js"></script>
<script src="js/jquery.chosen.min.js"></script>
<script src="js/avocado-custom.js"></script>
<script src="js/jqBootstrapValidation.js"></script>
<script src="js/bootstrap-datepicker.js"></script>
<script src="js/myScript/js_register.js"></script>
<script src="js/jquery.form.js"></script>
<script>
    $(function() {
		$("#txtRegisterDate").val(_cdate);
         $('#photoimg').live('change', function() {
		   $("#imgMap").html('');
            $("#imgMap").html('<img src="img/ajax-loader2.gif" width="220px" height="19px" alt="Uploading..."/>');
            $("#imageform").ajaxForm({
                target : '#imgMap'
            }).submit();
        });
	});
</script>
</html>